Multimodal drug addiction treatment: a field comparison of methadone and buprenorphine among heroin- and cocaine-dependent patients

Aims: Our objective was to compare the effectiveness of buprenorphine (BUP) and methadone maintenance treatment in opiate-addicted patients in a clinical nonexperimental setting. Design: We used a naturalistic observational prospective study of 24 months' duration. Setting: Subjects were enrolled and treated at a drug addiction outpatient clinic of the National Health System Local Unit in Milan, Italy. Participants: Two hundred fifty-seven subjects meeting the DSM-IV criteria for opioid dependence and opioid-seeking substitutive pharmacological treatment participated in the study. Intervention: One hundred twenty-one subjects received BUP at a mean daily dose of 11 [+ or -] 6 mg (median = 8; range = 2-30) for a mean duration of 249 days. One hundred thirty-six subjects received methadone at a mean daily dose of 54 [+ or -] 29 mg (median = 50; range = 4-140) for a mean duration of 267 days. Measurements: The main efficacy parameters were treatment retention rates and illicit substance abuse, as assessed by urinalysis. Findings: Retention rates were comparable in both treatment groups, but BUP-treated subjects had significantly lower rates of illicit opiate consumption (p < .0001). Conclusions: The results confirm that, in a nonexperimental clinical practice setting, BUP is as effective as methadone in the treatment of heroin dependence, with significantly better opiate abuse control, thus possibly allowing longer and more effective treatment programs with reduced relapse rates. Keywords: Buprenorphine; Methadone; Treatment effectiveness